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Prehospital Emergency Care, 1-7. Background. The most commonly used (and recommended) site for intraosseous (IO) access in pediatric patients is the proximal tibia. The primary objective of this ...

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Proximal tibia: Anteromedial surface, 2-3 cm below the tibial tuberosity. Distal tibia: Proximal to the medial malleolus. Distal femur: Midline, 2-3 cm above the external condyle. Prepare the skin. Insert the needle through the skin, and then with a screwing motion perpendicularly / slightly away from the physeal plate into the bone.

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